51.

Kehoe RA. Misuse of edathamil calcium-disodium for prophylaxis of lead poisoning. J Amer Med Assoc. 1955; 157:341-342 (Jan. 22). (1582) [In his introduction, the author points to the enthusiasm that has greed the development of a satisfactory compound of EDTA (CaNa2) for clinical trial in the treatment of Pb poisoning; this focuses attention to the fact that despite the availability of methods for the detection and control of hazardous absorption of Pb in industrial workers and others, a high incidence of Pb encephalopathy in children and dangerous absorption in industry still exists. He then warns against the suggested misuse of this promising therapeutic agent as a preventive agent, administered orally. Such application is reminiscent of the former attempts by physicians and others to relieve the effects of current excessive absorption of Pb with milk, etc., for the purpose of "fixation" of Pb in the skeleton, followed periodically by prophylactic "mobilization," as based on the investigations of Aub et al (1926). Because of the inadequacies of analytical methods at the time, it was believed mistakenly that these opposed effects on Pb metabolism could be affected by shifts in the Ca metabolism in the corresponding direction. The fault of any such method is that they were often used in place of environmental control.
Kehoe points out that the iv or im administration of EDTA in limited dosage and over brief periods of time is essentially safe, and that the drug is well tolerated by adults and children. It combines with Pb in the soft tissues and is rapidly excreted, mainly via the kidney. As it is unable to penetrate into the erythrocytes, the Pb content in blood is not reduced as promptly and completely as by use of BAL. Administered orally, it is comparatively poorly absorbed from the gastrointestinal tract. Although there is a slight to moderate increase in urinary excretion of Pb, there is a corresponding decrease in fecal excretion. Thus, if a significant increase in elimination of Pb were to be achieved, the virtually continuous use of the drug would be required. As there is no prediction of the consequences of such a regimen, the subjection of men to it, except for cautious investigation under proper safeguards, could only be regarded as rash and irresponsible.]

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